Weapons of Mass Corruption (WMCs) Part V: “Out-of-Pocket” Costs

May 14, 2018

I know what you’re thinking: How can knowing your out-of-pocket healthcare costs be used as Weapon of Mass Corruption? Read on…

A 2014 article in Modern Healthcare reads, “New CMS policy on releasing doc pay data and ACA provision requiring hospitals to disclose charges may signal full price transparency is inevitable.” The article is worth reading, as are the links in the article.

It’s 2018. In many ways, we’ve taken steps backwards since 2014. The article was optimistic. The reality is, it never happened. Hospitals are still not complying with the ACA and no penalties have been imposed on them. The suggestions this week (about 11 minutes into the video) by HHS Secretary Alex Azar that transparency is coming is refreshing, but we should all be skeptical about the implementation of any such rules. They didn’t happen in 2014 and they’re not likely to happen now. That’s what we have to keep the pressure on. The healthcare industry lobbies hard. It makes “suggestions” to regulators. But ask yourself, who is making suggestions as the representatives of patients and employers? No one.

The healthcare industry has taken control of the conversation and, in many ways, has snowed government officials. When it comes to drug prices, here’s a quote from a VOX article a couple of days ago: “Under Trump, drug companies have undertaken a concerted campaign to shift the discussion about drug prices to a conversation about out-of-pocket costs.”

Knowing our out-of-pocket costs accomplishes nothing. In fact, in many ways, it plays into the drug companies’, hospitals’, and insurance carriers’ games. When it comes to drugs, if all we know is our out-of-pocket cost and not what our insurance carrier is paying, then we are doing nothing to drive costs down by making better decisions. If in one place a drug costs $100 and in another it costs $50, but we only know that we have a $10 co-pay (i.e., “out-of-pocket”) then who is pushing for the $50 price? No one. And thus this game of charades leads to higher prices for us and our employers. Partial transparency equals no transparency. That’s why “out-of-pocket costs” is a Weapon of Mass Corruption.

As this article suggests, we are stuck with “half-measures” and the truth is that partial transparency equals no transparency. Legislative philosophy in this country promotes the idea of incremental steps. But in this case, the healthcare industry is carefully guiding those steps. And in doing so, they are perpetuating the status quo by creating the illusion of progress. The truth is that partial transparency is the same as no transparency, so incrementalism accomplishes nothing.

Imagine going into a supermarket where the price of everything is on display. When you check out, your bill reads, “$146.50.” You turn to the clerk and say, “I’d like an itemized receipt,” so she reprints it. This time it says: Vegetables: $15.98, Fruits: $13.12, Deli: $9.95, Paper Goods: $12.76 and so on. Then you say, “no, no, no…I want a truly itemized receipt.” This time it lists everything out, just the way you’re used to, but at the bottom is says, “after you leave the store, our analysts assess a service charge that will show up on your credit card bill. It is based on the following factors: a) how much time you spent in the store, b) how many things you removed from the shelves and replaced, c) whether you used a basket or shopping cart, d) whether you bagged yourself or we bagged for you, and e) whether or not you took up a parking spot in the parking lot.”

Not knowing if that service charge might be $1 or $100, you realize that knowing the prices of everything else turns out to be relatively useless because over time, the store has been shifting more and more cost into the service charge while bringing down the price of other things — creating the façade of lower prices.

These are the kinds of games played in healthcare. Secrecy enables the system to cheat us and our employers every day. Only complete transparency, without incrementalism or half-measures, will get the job done.

If you live in Colorado, please contribute to the Broken Healthcare Action Fund to help us change the law at the ballot box in November. We are collecting 140,000 signatures and it’s proving to be a very costly process. Volunteers have been great, but they can’t collect the more than 1,000 signatures we need every day.

And if you live outside of Colorado, please contribute to BrokenHealthcare.org where we help patients all over the country fight their bills and raise awareness of the issue of price secrecy. We’ve launched a GoFundMe account which is the easiest way to make a tax-deductible contribution and it’s very easy to share with your friends on Facebook or anywhere else. Even if you’ve given before, we need your help. Just $5 for each family member that ever results in a medical bill makes all the difference in the world. And please…share the GoFundMe campaign on your own social media account.

In the end, we need to build a system we can all #trust. We can only do it with your help.